Many surgical procedures involve placing an implant into bone. In some instances, the implant is driven directly into the bone, while in other instances, a bone hole is pre-formed in the hole and the implant is secured within the pre-formed hole. The implant can have a variety of configurations, but a common implant used for soft tissue repair is a suture anchor in combination with a suture. The anchor is disposed in the bone, and the suture or filament is coupled to the anchor, engages the tissue, and is tied or otherwise secured to maintain a location of the tissue with respect to the bone in which the anchor is implanted. In some exemplary procedures, the anchor and related suture can be configured such that a surgeon does not need to tie any knots during the course of the procedure.
One particularly complex anatomy for inserting a suture bone anchor is the shoulder joint, for example, during a glenoid labrum fixation procedure. During traditional glenoid labrum fixation procedures, one or more bone anchors are inserted into the bone through cartilage adjacent to the glenoid rim. The glenoid rim can be small, difficult to access, and can have an irregular surface, making it difficult for surgeons to insert an anchor into the glenoid rim at a location that is far enough away from the edge to prevent the implant from overly damaging the bone. Although this procedure has been traditionally performed through open surgical techniques, recently there has been a shift to provide for a minimally invasive form of glenoid labrum fixation, which further complicates correct placement of the knotless suture bone anchor on the glenoid fossa.
Moreover, typically knotless suture bone anchors require that a suture be passed through or otherwise coupled to the anchor prior to fixing the anchor in the bone. In some such instances, a guide wire or other such guide device can be used to help align the anchor being implanted into a desired location in the bone. The additional instrumentation can consume more space at or near the surgical site, create more potential points of failure, and can increase the amount of time a procedure takes by virtue of having to operate more instrumentation. Furthermore, in some embodiments, a surgeon may install the anchor without the use of a K-wire or other such device to direct the anchor to a drill bore in the bone, for instance because the tool is difficult to use in a small surgical area or is otherwise unavailable to the surgeon for a particular type of procedure. Thus, during a minimally invasive glenoid fixation procedure, for example, poor visibility can result in situations where it becomes hard to find a pre-formed bore in the bone for installing the suture anchor.
Present knotless suture bone anchors can be difficult to use in procedures with poor visibility at the surgical site. In some instances, it can take one minute or longer just to locate a bore into which an anchor is to be implanted, and in some extreme instances the bone hole may not be found, and thus a new hole is formed. Further, due to the relatively small size of the bone hole and the bone anchor, it is often difficult to insert the anchor, even when visibility is not an issue. This is particularly the case when using knotless anchors in which the suture is advanced ahead of the anchor, and thus, the suture may become sandwiched between the distal end of the anchor and the bone. This can result in lower resolution feedback from the distal end of the anchor sliding across the bone, referred to as “soft” feedback, and can make finding the drill hole even more difficult because it will be harder to feel any differences in the surface features, e.g., the bore, of the bone.
It is therefore desirable to provide devices and methods for use in soft tissue repair that allow for an implant location to be easily identified by a surgeon so the device can be easily inserted to the proper location even when the surgeon's visibility during the procedure is poor, while also avoiding suture entanglement during the repair procedure.